Proactive physiotherpay

Understanding Sacroiliac dysfunction or iliosacral dysfunction????

Sacroiliac joint dysfunction (SIJD) is a common cause of LBP occurring in 16–30% of patients with LBP. The sacroiliac joint is a diarthrodial synovial joint comprising an anterior segment, which is a true synovial joint, and the posterior segment, a syndesmosis comprising the gluteus minimus and medius muscle, piriformis muscle, and sacroiliac ligament. As all these muscles are shared with the hip joint, the sacroiliac joint (SIJ) cannot function independently. Furthermore, the ligamentous structures and the muscles influence the stability of the SIJ. The nerve supply for SIJ is mainly by the sacral rami dorsal.

The sacroiliac (SI) joint is formed by the articulation of the pelvis and the sacrum.  Dysfunction of this joint can result from how the pelvis impacts on the sacrum or how the sacrum impacts on the pelvis.  If the pelvis (ilium) is responsible for a fixated (immobile/stuck) SI joint, then it is called ‘iliosacral dysfunction’.  If the sacrum is responsible, it is called ‘sacroiliac dysfunction’.

Recent interest in rehabilitation involving the SI joint may be attributed in large part to the fact that approximately 20-30% of low back pain and referred pain comes from the SI joint itself and/or the surrounding ligaments, muscles and other soft tissues involved in the functioning of the joint  (Maigne et al, 1996, Schwarzer et al, 1995).

The concern in sports medicine relates primarily to the problems caused by the biomechanical changes inherent to the malalignment: specific sports injuries, impaired recovery from injury, and a failure of athletes to realize their full potential (Schamberger, 2002).

Sacral Motion and Dysfunction

When you forward bend, your sacral base moves in a posterior and slightly superior direction.  When you bend backward, your sacral base moves in the opposite direction, anteriorly and inferiorly.  The anterior and posterior movement of the sacral base is called nutation and counternutation, but many practitioners use the terms anterior nutation and posterior nutation.  “Nutation” means “nodding.”

Sacrum are also capable of side-bending and rotating.  If there are no joint fixations, then this is what your sacrum does in walking (or running) as you shift your weight from one leg to the other.  Most experts agree that the sacrum only exhibits ‘Type 1’ motion, meaning that side-bending and rotation are coupled to opposite sides (right rotated and left sidebent is known as ‘right torsioned’, left rotated and right sidebent are known as ‘left torsioned’).

The combination of side bending and rotation is also known as ‘torsion.’ When the sacral base is ‘right rotated’ the right sacral base is posterior in relation the left sacral base, and vice versa.  If during an evaluation, you find that the sacral base is rotated (on either side) when you are in the neutral position (standing on two feet), then it is probably dysfunctional.

For instance, if an SI joint evaluation reveals that (in a neutral position) the sacral base is fixated on the right side, then you must determine whether the right sacral base is fixated in anterior or posterior nutation.  Making the correct diagnosis is essential because you must treat the fix side to correct the dysfunction.  Treating the non-fix side will be meaningless.

Why is this important to know?

In cases of pelvic dysfunction, the side that hurts is often the side of the symptom (pain), but not the side that is fixed.  Most practitioners will try to treat the symptomatic side instead of the fixed side. There is a high probability that they will not be the same, and as stated previously, this work will be relatively meaningless.

Hip (Ilium) Motion and Malalignment

When we walk or run our hips rotate reciprocally in all three planes of motion.  These are the ‘sagittal plane’, the ‘coronal’ plane, and the ‘transverse’ plane.  In the sagittal plane, a type of hip rotation (malalignment) occurs as anterior or posterior rotation.  In the coronal plane, a type of hip rotation occurs as upslip or downslip (this is also known as superior or inferior shear, respectively).  In the transverse plane, a type of hip rotation occurs as inflare or outflare (this is also known as medial or lateral rotation, respectively).

If you discover an iliosacral fixation, at first you will only know the side of the fixation.  You must then determine the type of malignment involvement wheather it is anterior/posterior rotation, inflare/outflare, upslip/downslip.  Occasionally, an individual will present with a single malalignment.  Typically, an individual presents with a combination of two malalignments. A triple combination is possible, but relatively rare.

Remember again, you must treat the fixed side.even if the contralateral side is the symptomatic side.  In the case of a single-type of malalignment, just go ahead and treat according to the appropriate technique.  In the case of a combination of malalignment types, you must treat with the appropriate techniques(s), but also in the correct sequence.  The correct sequence is critical because if your sequence is wrong, your work will be ineffective.

After you release the fixed side, you can treat the symptomatic side (especially if they are not the same side) to speed up the healing process on that side.  This healing process will probably happen on its own but may happen faster with treatment.  Again, the sequence is the key.


The passive straight leg raising test is most helpful in the evaluation of pain in the low back. Pain down the leg on passive straight leg raising, which is exacerbated by dorsiflexion of the foot, is indicative of sciatic nerve pain. Despite a study to the contrary by Danforth and Wil~on,’~ several researchers have found a relationship between sciatic nerve pain and pain in the sacroiliac joint.When the leg is raised, the pull of the hamstrings on the innominate bone causes a posterior torsion strain on the same side.

If this does not increase the pain in the back or if it eases the pain in the back, anterior dysfunction should be suspected. If passive straight leg raising causes pain or increases the pain on the same side, suspect a posterior or vertical complication.


The use of ‘direct’ techniques in treatment, the more effective the results will be.  The use of indirect techniques, however, usually indicates less than a full grasp of the biomechanical descriptions and how to more precisely locate and treat the joint fixation.

Knowing what you are releasing in a client’s body adds to your clarity of purpose and makes you a more effective therapist. The techniques you apply will be more effective than if you don’t know precisely what you are releasing.

 Knowing and naming what you are working on is an essential part of effective therapy.

Reference :

  1. Maitland, J.  Spinal Manipulation… 2001.  North Atlantic Books, Berkley, California.
  2. Schamberger, W. The Malalignment Syndrome, Implications for Medicine and Sport.  2002.  Elsevier Science Limited.
  3. Maigne J-Y, Aivalikis A, Pfefer S.  Results of sacroiliac joint double block and value of sacroiliac pain provocation tests in 54 patients with low back pain.  Spine 1996; 21: 1889-1892.
  4. Schwarzer AC, Aprill CN, Boduk N.  The sacroiliac in chronic low back pain.  Spine 1995; 20:31-37.
  5.  Bernard TN, Jr, Kirkaldy-Willis WH: Recognizing specific characteristics of nonspecific low back painClin Orthop Relat Res, 1987, (217): 266–280.
  6. Erhard R, Bowling R: The recognition and management of the pelvic component of low back and sciatic painJ Am Phys Ther Assoc, 1977, 2: 4–15.
  7. Image coutsey :wikipedia

Warning bells for gluteus inhibition



What does inhibited mean?

The neural input to a muscle is lowered .The muscle still works but it’s not as efficient to generate power.  To generate power during movement. Therefore it appears weak!! The body finds balance to complete movement task but unfortunately it finds another way for muscle in the movement pattern to do more. Therefore movers become stabilizer for the joint.

What’s the role of the glutes: They are the powerhouse of the lower limb.

The glutes action…

• Extend the hip
• Laterally rotate the hip
• Abduct the hip
• Adduct the hip
• Posterior tilt the pelvis
• Hips are designed for thrusting

1) Hip mobility :

When hip mobility is decrease think of glutes. . If the glutes are inhibited you aren’t stable. There will be difficulty in doing squat in many cases after surgery of lower limb if flutes are inhibited.

2) You find Low back pain without any     reason :

When you lose hip mobility your lumbar spine takes role of mobility,hence there may be more movement from the lower back. Lose movement in one place and you move more in another. To help your lower back from crying  activate your glutes.

3) Knee pain. :

The knee movement depend on what the foot say and the hip can control. To remember , traumatic knee injuries will inhibit the glutes. So always start Gluteus rehabilitation as part of knee injury

4) chronic ankle sprains. :

Poor hip control leads to vulnerability in proprioception and gait. When you find loss of ankle rocker during gait cycle , there is always restriction of hip extension. The main function of glutes  is hip extension. Unlock your ankle by improving ankle rocker .Problem solve and you wins.

5) Plantar fasciitis.:

oh it’s very common condition we face in our daily clinical practice. We have already discussed in our previous blog click on plantar fasciitis due proximal joint instability  Any problem in the feet check your glutes.

6) Shoulder decreased motion or pain. :

This is very tricky for you to think . You have question how it possible . See, The glutes connect to shoulder via the Posterior Oblique Sling. When glutes are inhibited the fascia becomes tight and shoulder range of motion is restricted. If you can’t generate force from the ground up . Many times and  lattismus dorsi is also inhibited. Hence forward when you see a patient of shoulder pain check his posterior oblique sling.

7) Tight psoas muscle :

The psoas is a functional opposite of the glutes. The psoas flexes the hip and glutes extend it. The psoas anterior tilts your pelvis and the glutes posterior tilt it. If the glutes are inhibited the lumbar spine becomes more unstable and the psoas turns into overactive to stabilize the lower back. When you find anterior pelvic tilt  think for the Gluteus.

8) Groin or hamstring pulls:

The hamstrings take over the primary work of the glutes to extend the hip. That extra work causes strain. The most common groin muscles to pull and get injured are (pectineus, adductor longus/brevis). They act as hip flexors, antagonist to the glutes. They are hip adductors, synergistic to the glutes.


Finally , activate them and wins the situation.


Thank you you for reading notes .any dought raise questions.

Selective exercise for cycling : What evidence say

It ’s ability of the trunk, lower back, pelvis, and hip region to generate effective and efficient generate power when external load act on it.

The ideal cycling position is one of a comfortable flexion with the pelvis supported by the saddle and arms supported by the handlebars. Moreover, cycling is non-weight bearing sports. Don’t think too much? how  “core stability” is important in cycling? Here we explain how it’s important.

During the pedal, stoke movement occurs in 3 planes; flexion-extension, lateral flexion, and rotation.

What does the evidence say?

Cyclists reporting lower back pain have been found to have an increase in lumbo-pelvic flexion and rotation (Burnett et al 2008). An inability to control the movement and position of the pelvis, especially excessive lumbar flexion, may cause undue strain on the lower back and pelvis which turns into pain and pathology (Burnett et al 2008).

It is very interesting that the cyclists with lower back pain had greater flexion in all cycling positions and their posture does not change from start to finish. Cyclist started in more a flexed position and stayed.Here the author gives a suggestion that the cause of back pain was due to positioning error rather than fatigue in the ‘core’ (Van Hoof et al (2012).

In 2007 study by Abt JP1Smoliga JM,  investigated the link between “core stability” and cycling. 15 highly trained cyclists were cycled to exhaustion before and after a core-fatiguing workout. The motion of both the knee and ankle increased following the core fatiguing workout. Unfortunately, Total frontal plane knee motion , sagittal plane knee motion , and sagittal plane ankle motion  increased after the core fatigue protocol. Only knee and ankle motion were measured so it difficult to know in the reduction of control movement in the lower limb. In addition to that whether it was due to reduced control and stability in the proximal joint. However, it does suggest that reduced control of lower limb movement was due to poor proximal stability and force transfer from the truck and pelvic region.

From the referances, we conclude the below exercise that is essential for cyclist.

Unlock Core”

The list of ‘core’ exercises is endless. We would recommend choosing few exercises that challenge trunk-pelvic-hip control and stability through different ranges.

Proactive physiotherapyProactive physiotherapyProactive physiotheray,Ahmedabad

Improvements in ‘core stability’ could promote greater trunk stability leading to improved force transmission to the pedals which helps in the maintenance of core stability. Improved core stability and endurance could promote greater alignment of the lower extremity when riding for extended durations as the core is more resistant to fatigue.


Referances :


  1. Comparing lower lumbar kinematics in cyclists with low back pain (flexion pattern) versus asymptomatic controls – field study using a wireless posture monitoring system . Wannes Van Hoof a,*, Koen Volkaerts a Manual Therapy 17 (2012)
  2. Lower lumbar spine axial rotation is reduced in end range sagittal posture as compare to neutral spine posture. Burnett A1, O’Sullivan P, Ankarberg L, Gooding M, Nelis R, Offermann F, Persson J.Man Ther. 2008 Aug;13(4):
  3. Relationship between cycling mechanics and core stability. J Strength Cond Res. 2007 Nov;21(4):

Anterior Oblique subsystem (AOS)

The Anterior Oblique Subsystem (AOS) is comprised of:

External Obliques
Abdominal Fascia/Linea Alba
Contralateral Anterior Adductors
Internal Obliques
Rectus Abdominis


Function (Brief):

Stabilization of the anterior kinetic chain Which including the joints of the pubic symphysis, hip, and lumbar spine. It transfer force between lower and upper extremities.


Functional Arthrokinetic:


The Anterior Oblique Subsystem plays very important for stabilizing anterior kinetic chain. This subsystem has little effect on joint arthrokinematics .

The AOS is responsible for eccentric deceleration of rotation and extension of the lumbar and thoracic spine –  when there is asymmetrical movement pattern that may lead to facet joint and posterior disk compression and has been indicated in lumbar spine injury.


The AOS is also involved in eccentric deceleration of an anterior pelvic tilt, especially during standing and pushing motions. As an anterior pelvic tilt includes lumbar spine extension with little sacroiliac joint (SIJ) motion. If you find any change in pelvic rotation and SIJ dysfunction which may involve AOS involvement.

The AOS directly stabilizes the pubic symphysis. There is a most notable relationship in the AOS synergy relative to pubis symphysis joint is the fascial continuity.


It provides an optimal function to control of rotation with, superior/inferior glide, and other accessory motions at the pubic symphysis which associated with the normal pelvic torsion during gait.


What happen when AOS dysfunction occurs?

There is asymmetrical movement occur in the lumbar and thoracic spine, SI joint and pubic symphysis via rotation of the spine and/or innominate. This dysfunction may present as


Register to access full text……………..

Core stability : Local as well as Global musculature

What is core ?

It is a muscular box with the abdominals in the front, paraspinals and gluteals in the rear, the diaphragm at the top,  and the pelvic floor and hip girdle musculature at the bottom. Within the “box” multiple muscles help to stabilize the
spine and pelvis as well as transmit forces through the kinetic chain.

Defination of core stability ?

The core through three subsystems, the passive subsystem, active subsystem, and the neural control subsystem. It was proposed that these subsystems were highly integrated and optimization of all three were necessary for normal biomechanics of the spine. If any one of these subsystems became impaired it could lead to instability of the spinal column predisposing an individual to injury, dysfunction, and pain.

Generally, core stability comprises the lumbopelvic-hip complex and is the capacity to maintain equilibrium of the vertebral column within its physiologic limits by reducing displacement from perturbations and maintaining structural integrity.

Objective of core strengthening:

Strength is defined as the maximum force that a muscle or muscle group can generate at a specific velocity. Power refers to the amount of force that can be generated in a given time period 10 repeatation maximum squat is a measure of absolute strength, where the force of a racket on a ball a  given velocity determines the amount of power that is Imparted to the ball.

The crucial question is how core strength relates to each of these situations.


Register to gain full access of this article…………….

Plantar fasciitis : proximal instability

Plantar fasciitis (PF) is the most common foot condition treated by health care providers.This painful condition can cause impairment of activity and disability.Patients usually report pain after palpation of the proximal insertion of the plantar fascia and plantar medial heel, and the pain is most noticeable when patients begin walking after a period of inactivity.Clinicians have used many approaches for treating pain and enhancing function.

Weakness in the gluteus region causes instability to your trunk that leads to excessive motion . The gluteus medius and gluteus minimus muscles control the sagittal plane motion of the body.

An anterior pelvic tilt : tight back extensors, weak glutes and hamstrings, weak abdominals, and tight hip flexors all commonly caused by prolonged sitting which activate reciprocal inhibition .  This anterior pelvic tilt leads to your body weight being shifted forward causing higher stress on Achilles’ tendon and plantar fascia.

A muscular imbalance cause a shift of weight but it also causes a misalignment the kinetic chain. Weak glutes and tight hip flexors lead to an internal rotation of the femur, causes a valgus position of the knee, tibial internal rotation, and ultimately excessive pronation which may loads the plantar fascia.

So include gluteus assessment in your plantar fascia patient . It’s not always plantar fasciitis is due to hip problem , but 70% cases it affect. Proper clinical reasoning give you better idea.


Stay tune with more updates…..

pic coutsey:


A sophisticated approach for plantar fasciitis


Plantar Fascia is a broad, dense band originating from anterior aspect of calcaneal tuberosity in form of 3 bands namely medial, central and lateral and inserting after dividing into 5 digital bands at metatarsophalangeal joints. It plays vital role in supporting the arch of foot and act as a shock absorber.

Plantar Fasciitis is an inflammation of the plantar fascia specifically at the insertion on calcaneal tuberosity.
• This commonly occurs due to overuse injury among those who stand for prolonged period of time or whose activities require maximal plantar flexion of ankle and simultaneous dorsiflexion of MTP joints and long distance runners.
• It even happens among individuals who have pes planus, tight tendo-achilles, weak foot muscles- tibialis posterior, poor shoe support and obesity or sudden weight gain. This typically can happen in absence of windlass mechanism.


Symptoms & signs:

• Swelling at the insertion site
• Temperature rise and redness
• Tenderness at calcaneal tuberosity
• Heel pain that is worse in the morning with     the first few steps and exacerbate with climbing stairs. At times it becomes difficult to rest the foot on the floor in the morning. With progression, pain may start interfering with activities of daily living.

Biomechanical alterations due to plantar fasciitis :

• Individuals with flat feet or pronated feet are more prone to develop plantar fasciitis.

• Chronic long standing cases of plantar fasciitis disturbs the windlass mechanism and so individuals with normal arch also start losing flexibility and shock absorbing capacity of foot and it results into collapsing of medial longitudinal arch. This ultimately causes flattening of arch and thereby disturbance in metatarsal break.

• Body being a kinematic chain, any alteration at one joint result into alterations/ compensations at other joints.

• Flattening of medial longitudinal arch causes pronation of the foot, which is combination of talocrural dorsiflexion, calcaneal eversion & forefoot abduction. Following this, to have body in one alignment, there results into talar adduction & plantar flexion, compensatory internal rotation of tibia & femur.

• These internal rotatory forces cause positional mal-tracking of patella which causes lateral gliding of patella. The ilio-tibial band, tensor fascia lata & lateral retinaculum gets tight. This results gradual development of patellofemoral dysfunction & thereby knee pain.

• Tight ilio-tibial band, internal rotation of femur causes imbalance of pelvis and causes pelvic-femoral and sacroiliac dysfunction which results into back pain. This may progress to change biomechanics till cervical region and even atlanto occipital joint.

• Thus in a nutshell foot pain can alter entire biomechanical chain- foot pain can result pain in knee, back and even neck.

How to approach ?

• Rest- till pain subsides in acute cases. Avoid prolonged walking, running and jumping.
• Before initiating weight bearing in morning, patient can be asked to move toes in warm water to lessen the pain.
• Cryotherapy can help reduce pain- 5-10minutes massage or ice pack application for 15-20 minutes; 3-4times daily.
• Needling , myofascial release and deep friction massage over the plantar fascia.
• Plantar Fascia stretching- can be done in different positions- patient/ therapist’s hold the heel of the affected foot with one hand and other hand’s fingers pulling the toes of affected foot into extension at MTP joint.

Proactive , plantar fasciitis treatment , massage

Woodstown massage:

• Stretching of the tendoachilles- gastrocnemius and soleus with the help of towel or theraband- ankle dorsiflexion with knee in extension for gastrocnemius and ankle dorsiflexion with knee in flexion for soleus. It should be gentle, slow, static & can be done in long sitting or standing- hold time 30-60 secs, 5 reps, 3 times/day.

• Tight fascia can be released by rolling the fascia over a tennis ball or bottle filled with cold water.

Ahmedabad India , treatment

Podantics podiatry

• Once the flexibility is gained and its painfree, strengthening exercises of calf and intrinsic foot muscles should be started, as this can prevent reoccurrence and can provide muscular support for weakened plantar fascia.

✓ Toe curling/ towel scrunching exercises: strengthens the intrinsic muscles of foot. Patient in sitting position with foot flat on the floor with towel placed underneath. Patient is asked to curl the toes to try to lift & pull the towel off the floor with the heel in contact with the floor throughout the exercise- done for 1-2minutes.

✓ Calf raises –unilateral & bilateral- 3 times/day for 20 rep in each session.

✓ Short foot exercises/ arch lifts- strengthen the muscles that support the medial longitudinal arch. The patient is asked to draw the metatarsal heads towards the calcaneus without flexing the toes or lifting the ball of great toe & foot, heel off the floor. Hold for 5 secs and relax- 1 minute. Initially done by sitting on chair with foot flat on floor and the gradually progressed in standing. It will require good amount of practice to master.


✓ Toe band exercises for toe muscles strengthening- elastic band is wrapped around all 5 toes. It should be fit yet comfortable. Instruction is given to move the toes apart pulling against the band- 3-5secs hold & relax-10-2-times.

✓ Toe squeezes for toe muscles strengthening- small sponges are placed between each toe. Instruction is given to squeeze the sponge with the toes- 3-5secs hold & relax-10-2-times.

✓ Mobilization can be given- talocrural posterior glide, subtalar lateral glide, anterior & posterior glide of 1st tarsometatarsal joint.

✓ Calcaneal taping may help in temporary reducing pain & function by distributing force away from stressed plantar fascia.

✓ Proper foot wear during daily activities and sports provides good support and prevents plantar fasciitis.

✓ Orthotic devices like Insoles can be used which acts as a soft cushion for heel-12-15mm higher than sole or well molded Achilles pad or heel cuffs or medial longitudinal arch support.

With proper care & physiotherapy, plantar fasciitis patients can become painfree and return to normal activities.


Next Friday post will be on how proximal joint dysfunction can cause plantar fasciitis

Stay tune!!!!

pic courtesy:

A new insight on back pain

In the early 20th century the SI joint was thought to be the main source of law back pain and was the focus of many scientific investigations. But recently two newest theories have been developed.

First, the theory of rotational malalignment known today as the Malalignment Syndrome which includes: SI joint upslip/downslip (superior/inferior shear), sacral torsion (hip anterior/posterior rotation), hip outflare/inflare (lateral/medial rotation), (Schamberger, 2002, 2006). Diagnosis of these syndromes is very straight forward, as is the treatment of each is

Second, the past 15 years, a well-known group of PTs, have been developing a newer theory that is known as the Joint-By-Joint Approach. This theory is based on understanding the primary role of the different major joints.

Of course all joints need a combination of mobility and stability, but interestingly, each joint displays a predominant need for either mobility or stability.

Lets start from the bottom which joint require mobility or stability…..

Ankles – mobility

Knees – stability

Hips – mobility

Lumbar Spine – stability

Thoracic Spine – mobility

Scapulae – stability

Shoulders – mobility

Cervical Spine (C7-C3) – stability

Cervical Spine (C2, C1) – mobility

Our CNS chooses mobility over stability depending on when we move. Another prospective , when a joint which predominantly requires mobility, reaches its mobility barrier ( it may be physiological or pathological), the surrounding joint will give up their stability to accomplish the mobility requirement. This is involuntary survival technique that is controlled by CNS.

How this above phenomenon will work with Hip and Spine lets understand.

Register to read full text

Guideline for Rotator cuff rehabilitation

There are many school of thoughts for RC rehabilitation, here we try to make you easy understanding how to approach . While assessing the rotator cuff in person .

when patient come to us after rotator cuff repair surgery we need to fully understand his daily activities affecting their ability to their normal life. Here there are few keys that need to be consider…….

Key consideration factors in Rotator Cuff Rehab :

• age of the patient,
• activity level,
• injury to affected shoulder,
• response to previous treatment,
• imaging and what were the findings,
• past medical history,
• joint status (hypermobile or hypomobile),
• what they think is going on in their shoulder,
• most importantly is the ultimate goal of the client.


Plan for treatment……..

what do we do for people presenting some form of shoulder pain? There are many different answers but for the purpose of this, we will keep it simple that will help restore
pain free ROM, strength, and slowly return them back to their functional level.

Control on the shoulder pain :

We want to get the shoulder joint moving through self-ROM activities. We prefered patient to go for foam roll their thoracic spine and Latismus dorsi muscles to achieve overhead shoulder mobility. We will work on external rotation ROM at 45 degrees and 90 degrees of abduction.

Following this exercise we prefer to work on shoulder flexion AAROM in supine position, once gradually ROM restore we’d prefer kinetic chain activation exercise.

For strengthening,we like to begin with isometric activities to help with pain control.


When to start  higher level strengthening programme:

Once you achieve all criteria for advanced training we would like to start strengthening activities, we add isotonic strength training with  theraband  : full can, sidelying external rotation, prone horizontal abduction, prone extension and prone full can. There are Many studies have shown the EMG activity of the rotator cuff and scapula stabilizers to be relatively high with most of these activities.

There are  evidance, we like to add program in our routine protocol but will change the weights, sets and reps depending on Patient tolerance during exercise.

We rarely have patients perform 3 sets of 10 repetitions so the goal of the exercise needs to be fully understood in order to prescribe it correctly.

Advanced strengthening :

Once an adequate base of strength is achieved , we will add another level of strengthening programme depending upon patient’s requirement. We also focus on proprioceptive exercise once adequate strength achieved.

For athlete , Plyometric strength training is incorporated to allow the athlete to produce a force and power in his sports activities. which will hopefully help them in their return to their sport. This may include chest press, overhead throws, and rotational throws etc…

Pull ups, push-ups, bench pressing and overhead pressing are also added to make sure the athlete is strong in multiple planes to performing his sports.

Finally,The key is knowing the ultimate goal of the athlete .there are many factors that need to be considered when returning a patient back to their highest functional level when they have a  cuff injury.

This post was my attempt at outlining a very general guideline for an athlete or non athletic poplution with a rotator cuff issue and what my thought process may be.

Remember, listen to their issues…they may just tell you what program is best for them!

Any question!!!!!!!


image courtesy:

Scapula stabilisation

Thoughts on Scapula exercise

Scapula exercises are very common and usually a needed to any shoulder rehabilitation or corrective exercise program.    No program is right for everyone!  Here are of scapular exercises that we thought would good to discuss.


1) Pinch Your Shoulder Blades Together :

Pinch your shoulder blades , Squeeze your scaps together.  Retract your shoulders back.  These are common coaching cues given during scapular exercises.  The goal of these concepts is to get into better posture and set your scapula  in correct postion ,ultimately resulting in  better movement patterns along with better posture  when performing exercises.

The classic example is Upper Body Cross Syndrome of forward head, rounded shoulders.

scapulohumeral rhythm requires a sequence of shoulder and scapular movement simultaneously.  Pinching your shoulder blades together is essentially contracting your middle trapezius to fully retract your scapula and then move your arm.  While this is not nearly as bad on shoulder mechanics as lifting your arm . it does not have good advantage to lift your arm in a fully retracted position. While fully retract the scapula  which is essentially performing and isometric trapezius contraction, you are likely to limit the normal protraction and upward rotation movement  that occurs  during arm elevation and movement.

If the milestone  of this to give cue for  improve posture and improve mechanics while exercising the arm, maybe a better cue would be to instruct thoracic extension.

Think about , you can still have a very kyphotic and rounded thoracic spine and retract your scapula, it’s. Very difficult to perform , but the goal is to really get your thoracic spine extended.

2) Mobility and Strength to Improve Scapular Symmetry.


To Read More Register Now or Log in

Onces you register with us you can access restricted content……

1 2